Rates for HEDIS Screening for Diabetic Nephropathy Quality Measure May Be Overstated.

The Healthcare Effectiveness Data and Information Set (HEDIS) is used by health plans to measure and report on quality and performance. This study evaluated the appropriateness of the prescription drug compliance step for the Medical Attention for Nephropathy quality measure for patients with diabetes. Data from national commercial claims for 28,348,363 persons were reviewed. The study applied the standard HEDIS specifications for compliance in medical attention for nephropathy for diabetic patients. Evaluation of the third and final process (evidence of angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blockers [ARBs]) found that the addition of this step contributed 14% to 16% of the numerator, bringing the final rate to the >80% range. Yet, presence of a prescription for an ACE inhibitor or ARB did not confirm microalbuminuria. Only 1% of the persons satisfying Step 3 had evidence of microalbuminuria in years prior and none in the reporting year. Use of these medications does not obviate the need for a nephropathy screening in diabetics. Inclusion of these medications as numerator compliance leads to overreporting and may contribute to underscreening of a population at risk.